Vitamin B12 – The Miracle for the Nerves

Vitamin B12 plays a central part in the health of our nervous system. That is why it matters so much not to fall into a lasting deficiency: the consequences can be very serious, including nerve damage that cannot be repaired. Many people wrongly associate a vitamin B12 deficiency with a vegan diet alone, when in fact a considerable share of the population is affected today. To understand how important vitamin B12 is for our body, let us look more closely at this vitamin, at what it does and how it works in us.

Vitamin B12 is one of the chemically most complex of all vitamins.

There are four different forms of vitamin B12:

• cyanocobalamin
• hydroxocobalamin
• methylcobalamin and
• adenosylcobalamin

Not every one of these forms is ideal for us. To understand why, let us look at the four in turn.

Vitamin B12 – cyanocobalamin

Unlike the other three forms of vitamin B12, cyanocobalamin is produced synthetically — and so „unnatural". Its depot effect — that is, how well it is stored in the body — is relatively poor. Before cyanocobalamin can be used, the body needs considerably more steps to convert it. It is therefore not only the least natural form but also the poorest one for our body, and it has no particular effect of its own.

Vitamin B12 – hydroxocobalamin

Hydroxocobalamin is a natural form of vitamin B12 and has the best depot effect. However, this form also needs a relatively large number of conversion steps in the body. It is particularly suited to the detoxification of cyanide and nitric oxide.

Vitamin B12 – methylcobalamin

Methylcobalamin is likewise one of the natural forms of vitamin B12. It needs no conversion steps and is therefore immediately available to the body. Methylcobalamin has only a medium depot effect, though, and must be taken regularly. This form of vitamin B12 plays an important part in cell division and repair, and in maintaining the genetic material in the cells. Methylcobalamin acts moreover like a neurotransmitter, regenerates and protects the nerves and the brain and helps, among other things, with the formation of blood.

Vitamin B12 – adenosylcobalamin

Adenosylcobalamin is also one of the natural forms of vitamin B12 and, like methylcobalamin, needs no conversion, so it is immediately available and has a medium depot effect. Adenosylcobalamin is essential for cellular energy, for the development of the brain, for hydration, nerve function, DNA synthesis, growth and muscle building.

The best forms of vitamin B12 for our health

Both adenosylcobalamin and methylcobalamin are bioactive coenzymes, meaning they work in the body as coenzymes that support many important enzymes in their tasks. Methylcobalamin works here in the cell plasma and adenosylcobalamin works only in the mitochondria, the power stations of our cells.

Broadly speaking, vitamin B12 is indispensable for our nervous system, for the formation of blood, for the way our genetic material is made (DNA synthesis), for cell division and for producing serotonin.

The various forms of vitamin B12 have different effects and functions, so one form alone is not enough. The best combination is methylcobalamin and adenosylcobalamin. If you want to be genuinely well supplied with vitamin B12, it is important to look for exactly that in a supplement. These are also the forms that work best where there are methylation problems. More on methylation further down in the article.

Perhaps you have had your vitamin B12 level measured at the doctor's and it came back fine. That does not mean it really is. Doctors usually test the TOTAL vitamin B12 level, and that total includes vitamin B12 that is not active. Your body can do less with that than with the active forms — particularly if there is a methylation disorder.

It says more to have only the active vitamin B12 tested. Unfortunately most doctors are not even aware that there is a difference. And even if the level of active vitamin B12 in the blood were good, there can still be a deficiency in the nervous system, in the liver (where vitamin B12 is stored), in the cells and in other parts of the body. If you want your vitamin B12 measured, ask for „holo-transcobalamin" (holo-TC). Better still would be to have the long-term marker methylmalonic acid in urine or blood tested.

Food supplements can help to keep vitamin B12 levels adequate, particularly with special diets such as a vegan one.

As mentioned, a vitamin B12 deficiency is widespread and can cause serious damage over time, sometimes irreversible damage that cannot be repaired.

Vitamin B12 and DNA synthesis

A lack of vitamin B12 can mean that DNA synthesis — the process of creating new DNA in the cells — no longer works without errors. That is critical, because DNA is needed for cells to divide correctly and to renew themselves.

When DNA synthesis is impaired, cells cannot divide or renew properly, which shows up especially in fast-renewing tissue such as the mucous membranes. The membranes lining the inside of the mouth, the nose and the digestive tract normally renew themselves very quickly. A vitamin B12 deficiency can disturb that renewal, which can show as abnormalities in the mucous membranes, delayed healing or other impaired functions.

Vitamin B12, blood synthesis and the nervous system

Blood synthesis is disturbed by a vitamin B12 deficiency too, which can lead to anaemia and pallor, chronic fatigue and delayed wound healing. The amino acid homocysteine cannot be broken down. That leads to the molecule accumulating in the blood vessels and can encourage cardiovascular disease.

Too much homocysteine also encourages inflammation in the body. The nervous system is damaged. That can lead to problems with movement coordination, trouble concentrating, states of confusion, psychosis, dementia, brain fog and memory loss, low mood. Quite unspecific dizziness and general weakness can occur as well.

A vitamin B12 deficiency affects the nervous system above all and can lead to serious nerve damage. This nerve damage often cannot be repaired and can cause conditions such as restless legs syndrome, exhaustion and lack of energy, as well as neuropsychiatric disorders such as bipolar disorder, panic attacks and depression. A vitamin B12 deficiency is also associated with conditions such as Parkinson's and multiple sclerosis; there is no direct proof that a deficiency causes these diseases, but it can make existing symptoms worse.

Vitamin B12, skin problems and more

A vitamin B12 deficiency can also cause skin problems such as acne and eczema, gastrointestinal disorders such as small intestinal bacterial overgrowth, digestive problems and vision problems. Allergies, tinnitus, thyroid problems, arthritis and weak muscles can be traced back to it as well.

Possible signs of a vitamin B12 deficiency at a glance

• diseases of the nervous system (Parkinson's, multiple sclerosis)
• restless legs syndrome
• exhaustion and lack of energy
• bipolar disorder
• panic attacks
• weight problems
• migraine
• twitching
• acne
• eczema
• small intestinal bacterial overgrowth
• allergies
• cancer
• anxiety
• ringing in the ears
• thyroid problems
• arthritis
• weak muscles
• developmental disorders
• digestive problems
• vision problems
• disturbed DNA synthesis
• disturbed blood synthesis (anaemia, pallor, chronic fatigue, delayed wound healing)
• the amino acid homocysteine cannot be broken down (the molecule accumulates in the blood vessels → cardiovascular disease; inflammation in the body)
• problems with movement coordination
• trouble concentrating
• states of confusion
• psychosis
• dementia
• brain fog and memory loss
• low mood
• unspecific dizziness
• disturbed methylation

Methylation and vitamin B12

Methylation reactions are a central building block of our lives. They are needed for countless bodily processes: controlling DNA and epigenetics, forming new DNA and RNA, immune function, making and regulating neurotransmitters and hormones, detoxification, energy, protein methylation, phospholipid methylation and so on. Methylation happens in every single body cell — thousands of times a second. Without these reactions, normal cell function would not be possible at all.

Methylation simply means transferring methyl groups from one molecule to another. Certain enzymes mediate the process: one molecule gives up the methyl group and the other takes it on.

Methylation very often works as a kind of on or off switch. Genes as well as certain molecules can be activated or deactivated by it. Methylation matters in many conversion reactions in the body and provides a whole range of important substances that way. And vitamin B12 has a decisive part in this vital process. Where methylation is disturbed, a great many of the health problems named above can arise — problems affecting the nervous system, cardiovascular health and general cell function.

The MTHFR mutation and vitamin B12

It is worth knowing that there are genetic mutations that can impair the methylation of vitamin B12. These mutations are in fact relatively common. One of the most frequent is the MTHFR gene mutation (methylenetetrahydrofolate reductase). It affects the body's ability to convert homocysteine into methionine, which can lead to raised homocysteine levels and a shortage of the methyl groups the methylation cycle depends on.

People with an MTHFR mutation have difficulty converting folic acid into its active form (5-MTHF), which is needed to break down homocysteine. That in turn can impair the use of methylcobalamin (the active form of vitamin B12), since the two substances work together to keep methylation going.

There are several variants of the MTHFR mutation, the most common being C677T and A1298C. People with a mutation in both copies of this gene (homozygous) are more strongly affected and may benefit from supplementing with the active forms of B12 (methylcobalamin + adenosylcobalamin) and folate (5-MTHF).

Other genetic variants affecting enzymes in B12 metabolism, such as mutations in the MMACHC gene, can likewise disturb methylation and lead to an inherited vitamin B12 deficiency.

Where a methylation disorder is suspected, it is therefore advisable to have genetic testing done and to adjust supplementation in consultation with a doctor.

More on methylation in the article Methylation and methylation disorders.

I think I have made clear how important vitamin B12 is for our body, and for a healthy mind as well. The right form of vitamin B12 gives you a mental and emotional boost. Incidentally, vitamin B12 also protects your body against damage from neurotoxins released by viruses and bacteria.

A high-quality vitamin B12 supplement with methylcobalamin and adenosylcobalamin at the right dose can help you recover from symptoms and set you on the path to healing.

Why supplement vitamin B12 at all? Can we not simply get enough from food? The thing is, in theory we are even able — or rather, we WERE able — to take up vitamin B12 in the gut through the microorganisms living there, because they can produce vitamin B12 themselves. Unfortunately none of us has a gut healthy enough, with exactly the right microorganisms, to secure the supply that way. The conditions in the body are simply no longer there. On top of that, bacteria mostly produce vitamin B12 in the large intestine, an area where absorption does not work well, because the main uptake happens in the last section of the small intestine.

Foods high in vitamin B12

Most people take in vitamin B12 through animal products. Animal products from farmed animals contain vitamin B12 because these animals are naturally good at absorbing the vitamin B12 that bacteria produce in their bodies. We could of course also take in vitamin B12 by eating plants. For that, though, we would have to eat untreated and above all unwashed fruit, vegetables and especially green leafy plants such as herbs — ideally wild herbs — every day. Which of us does that daily? Why unwashed? Because the microorganisms that could then produce vitamin B12 in our gut sit on the surface of the plant. Plants themselves contain no vitamin B12.

You can see that vitamin B12 is a little awkward. Even if we do get some from animal products, it will be too little to make us feel genuinely well and to avoid health problems later on. On a vegetarian or purely plant-based, that is vegan, diet, vitamin B12 should certainly be supplemented.

If your vitamin B12 stores are well filled, your body can manage for some time without a fresh supply. Entirely without vitamin B12 we die. That is how critical it is.

When does the need for vitamin B12 rise?

Various factors and situations in life can raise the need for vitamin B12.

The most common reasons for a higher need are:

• a vegan or vegetarian diet
• eating disorders
• pregnant and breastfeeding women, whose need for vitamin B12 together with folic acid is higher
• children who are growing
• gastrointestinal disease
• diseases of the nervous system that go back to vitamin B12
• impaired intrinsic factor (pernicious anaemia)
• older age, since the ability to absorb vitamin B12 from food can decline
• taking medicines such as proton pump inhibitors or metformin
• raised physical activity (in competitive athletes, for example)
• genetic factors that impair the body's ability to absorb vitamin B12

Intrinsic factor and vitamin B12

Vitamin B12 gets into our bloodstream by way of a protein formed in the stomach lining, called intrinsic factor. It binds the vitamin B12 to itself. And here lies a problem, because intrinsic factor is not always produced, or not produced strongly enough by everyone.

This problem is essentially one of the most common reasons for widespread vitamin B12 deficiency in the population. Vitamin B12 can to some extent also be taken up passively, that is without intrinsic factor, but only where the concentration is high and it is absorbed through the lining of the mouth, for example in the form of drops.

If you decide to take vitamin B12 as a supplement, whether to make up a deficiency or to support you through an illness, the dosage recommendations differ.

Vitamin B12 dosage recommendation of the German Nutrition Society (DGE)

The German Nutrition Society, for instance, sets its recommendation very low.

These are the dosage recommendations for vitamin B12 according to the German Nutrition Society (DGE):

• infants (0–4 months): 0.5 µg a day
• infants (4–12 months): 1.4 µg a day
• children (1–4 years): 1.5 µg a day
• children (4–7 years): 2 µg a day
• children (7–10 years): 2.5 µg a day
• children (10–13 years): 3.5 µg a day
• adolescents (13–19 years): 4 µg a day
• adults (19–65+ years): 4.0 µg a day
• pregnant women: 4.5 µg a day
• breastfeeding women: 5.5 µg a day

Source: German Nutrition Society

Vitamin B12 dosage recommendation in orthomolecular medicine

The dosage recommendations in orthomolecular medicine, which aims to use nutrients in optimal amounts to prevent and treat illness, are set considerably higher.

General dosage recommendations for vitamin B12 in orthomolecular medicine:

Prevention and general health:

• adults: 500 to 1,000 µg per day
• children (1–4 years): 100 to 500 µg per day
• children (4–7 years): 200 to 500 µg per day
• children (7–10 years): 300 to 1,000 µg per day
• adolescents (10–19 years): 500 to 1,500 µg per day

A higher dose of vitamin B12 may be appropriate especially for older people, for vegans and for anyone with digestive problems that can impair absorption.

Treating deficiency:

Where a vitamin B12 deficiency has been established, considerably higher doses may be needed at first.

• adults: 1,000 to 5,000 µg per day, often as injections or high-dose oral preparations
• children (1–4 years): 500 to 1,000 µg per day, split across several doses
• children (4–7 years): 500 to 1,000 µg per day, split across several doses
• children (7–10 years): 1,000 to 2,000 µg per day, split across several doses
• adolescents (10–19 years): 1,000 to 3,000 µg per day, split across several doses

Chronic illness:

Higher doses can also be used when treating certain chronic conditions, such as neurological disorders linked to a vitamin B12 deficiency. This should be discussed with a doctor and supervised by one.

If you would like to read up in more detail on dosing vitamin B12 and other vital nutrients, I recommend the two reference works by Dr Helena Orfanos-Boeckel: Nährstoff-Therapie - Orthomolekulare Medizin & Bioidentische Hormone and Nährstoff-Therapie - Der Praxisleitfaden.

A vitamin B12 supplement in drop form, made up of methylcobalamin and adenosylcobalamin, is particularly well suited, because it can be absorbed through the lining of the mouth. A ratio of 80/20 has proved itself — that is 80% methylcobalamin and 20% adenosylcobalamin. It is best to choose a vitamin B12 supplement without alcohol. Take it on an empty stomach and hold the drops in your mouth for 20 to 30 seconds so that they can be absorbed as well as possible.

There are also vitamin B12 lozenges. Be aware that these often contain sugar and other additives. I have yet to find a product I would recommend.

Vitamin B12 tablets and vitamin B12 capsules are only worth recommending where it is certain that intrinsic factor is not a problem.

There is even toothpaste with vitamin B12. Here it is worth checking which form of vitamin B12 it contains. The concentration in toothpaste is usually not high enough to cover the need.

Where the deficiency is severe, or where a chronic illness goes back to it, your doctor can inject vitamin B12. That said, the ideal combination of adenosylcobalamin and methylcobalamin is usually not what is used. And putting such a high amount of vitamin B12 straight into the blood can trigger over-reactions, particularly if your body is a sensitive one.

Most vitamin B12 supplements use methylcobalamin or the cheaper synthetic cyanocobalamin. The concentration of vitamin B12 in these supplements varies.

With food supplements, quality is what matters. There are a great many preparations on the market that are full of additives which can harm the body over time. You can rely on us to recommend only the best products — of very high quality and free of harmful additives.

Overdosing on vitamin B12 is practically impossible. Because vitamin B12 is water-soluble, any excess is passed out again in the urine.

Vitamin B12 supplements are generally very safe and have few known negative interactions with medicines. Even so, there are some medicines where an interaction with vitamin B12 is possible and worth watching. The following can impair vitamin B12 uptake: proton pump inhibitors, H2 receptor antagonists, metformin, cholestyramine, colchicine. Chloramphenicol and neomycin, both antibiotics, can impair vitamin B12 metabolism. If you take medicines, please talk it over with your doctor.

Extremely high doses of vitamin B12, particularly by injection, can in rare cases lead to symptoms:

• skin rashes and itching, acne
• nausea, vomiting, diarrhoea
• headaches
• dizziness and feeling unwell
• nervousness and anxiety
• allergic reactions such as difficulty breathing, swelling (face, lips, tongue, throat), severe skin rashes